Rheumatology Flashcards
Erythrocyte Sedimentation Rate (ESR) measures?
Marker for?
Distance RBC falls in 1 hr
Inflammation (nonspecific) ->
inflamm dzs cause RBCs to settle more quickly
C-Reactive Protein (CRP) is?
Tells us?
P marker for?
Protein made by liver during acute inflamm
Inflamm (nonspecific), bacterial inf, tissue necrosis
More sensitive than ESR
CAD (due to inflamm plaques)
Antinuclear Antibodies (ANA) + results tells us?
Inflamm (nonspecific)
P SLE, Sjogren, scleroderm, RA, JRA, fibromyal
ANA patterns a/w:
Homogenous?
Rim?
Speckled?
Nuclear?
Homogenous: SLE, CT
Rim: SLE
Speckled: many
Nuclear: sclero
Antibodies to Double-Stranded DNA (anti-dsDNA) are?
Tells us?
Titers fluctuate?
Anti-nuclear antibodies targeting double stranded DNA antigens
Very specific but not sensitive for SLE
P + result w/ other rheumatoid dzs
Can monitor dz activity
w/ flares
Antibodies to Single-Stranded DNA (anti-ssDNA) are?
Tells us?
Anti-nuclear antibodies targeting single stranded DNA antigens
Non-specific for SLE, RA, Drug SLE
Antibody to Smith Antigen (anti-Sm) is?
Specific for?
Used for?
Ab against Smith proteins
SLE but only 25% have it
P dx if DNA testing -
Anti-phospholipid Antibodies tell us about which antibodies? (2)
Limitations of test?
Why do we care?
Anticardiolipin AB
Lupus Anticoag
+ doesn’t mean SLE
40% of SLE pts have them -> ↑ risk for: Thrombosis Spontaneous abortions Neuropsych disorders Thrombocytopenia
Anit-Histone Antibodies + when?
U induced by? (6)
Drug-induced SLE
Procainamide Hydralazine Isoniazid Methyldopa Quinidine Chlorpromazine
Rheumatoid Factor (RF) is?
Best used when?
Can also be + with?
Titer NOT useful for?
Ab against IgG -> forms immune complex that targets healthy tissue
Already suspected RA (80% test +)
Many false +
Sjogren, CT, hep, etc
Following dz progression
Anticyclic Citrullinated Peptide Antibody (Anti-CCP) is?
Very specific for?
Abs against citrullinated synovial proteins
RA
Rarely + w/ other dz
ANA subtype: Anti-SSA/Ro is?
Tells us?
Anti-nuclear Ab
strong a/w primary Sjogrens
ANA subtype: Anti-SSB/La is?
Tells us?
Anti-nuclear Ab
strong a/w primary Sjogrens
ANA subtype: Anti-SSC is?
Tells us?
Anti-nuclear Ab
a/w Sjogrens 2° to RA
Human Leukocyte Antigen B27 (HLA-B27) tells us?
Seen with? (4)
Only helpful when?
Marker for risk of spondylopathies
Ankylosing Spondy (90% +)
Reiter’s (80% +)
Psoriatic arth
IBD arth
Already suspect Anky Spond
.
.
.
.
SLE best test?
Results?
Run test when?
Antinuclear Antibodies (ANA) (95% of SLE will have ANA)
+ w/ staining patterns and titer
Patterns: Homogenous, Rim and Speckled
Titer: Higher = higher likelihood of dz
Only pts meeting ACR criteria
SLE most specific test?
anti-dsDNA (97%)
but only 60% of SLE have + test
Antiphospholipid Antibody Syndrome triad?
Who gets this?
Eval pts for this when?
thrombosis + miscarriage + thrombocytopenia
NOT just SLE, anyone
Recent unexplained CVA, MI or miscarriage
Drug-induced SLE lab tests?
Anti-histone Ab = +
Anti-dsDNA = -
Anti-Sm Ab = -
Signs of RA? (3)
Boutonniere (ext DIP, flex PIP) Swan neck (flex DIP, ext PIP) Ulnar deviation (MCP)
RA lab tests? (4)
RF = + or - Anti-CCP = + (VERY SPECIFIC) ESR = ↑ CRP = ↑
Sjogren’s Synd is?
a/w?
Causes?
Autoimm dz of exocrine glands
other rheum dzs (RA)
Dry eyes/muc mem
“Keratoconjunctivitis sicca”
Keratoconjunctivitis sicca is?
a/w Sjogren’s
lymphocyte and plasma cell infiltration of lacrimal glands
Sjogren’s Synd lab tests? (7)
CBC = mild anemia, leukopenia, eosinophilia
RF = + or -
anti-SSA/SSB = +
Electrophoresis = polyclonal hypergammaglobulinemia (over cloning of gamma)
Schirmer test = for tears
Lip bx
Salavary gland bx (if atypical presentation)
Polymyalgia Rheumatica (PMR) is?
Presentation?
Lab test?
Rheum inflamm dz U involving neck/torso, shoulders/prox arms, hips/prox thighs
> 50yo
Bilat aching/stiff in a.m. in 2 of 3 above
a/w Temporal Arteritis
ESR > 40
Ankylosing Spondylitis is?
Lab test?
Inflammatory disease causing fusion of vertebrae
HLA-B27 (90% +)
